"Marriage Format Bio Data"
number 15 in a series on Reproductive Health and HIV/AIDS Early Marriage and Adolescent Girls Girls at risk of child marriage and those already married need greater policy and programmatic attention. Programs addressing adolescent reproductive Early Marriage Risks health and HIV prevention have focused primarily When girls are married at a young age, it is often due on unmarried youth. However, the majority of to poverty, dowry pressures, parental concerns about recent unprotected sexual activity among adoles- premarital sex and pregnancy, or other economic cent girls in most developing countries occurs or cultural reasons. For many, marriage marks the within marriage. Girls married before age 18 have beginning of their sexual life and an increased social low educational attainment, earning power, and isolation, as girls typically leave their homes and social mobility. In some settings, married girls have natal villages, losing contact with friends and peers. been shown to have higher rates of HIV infection Existing data cannot definitively show the causal links than their sexually active unmarried peers.1 between early marriage, poverty, low educational attainment, and other social indicators, which are All regions have countries with areas where early likely multi-directional. However, studies have found marriage is prevalent, but it is most pronounced that married girls have many disadvantages related in South Asia and West Africa. In Bangladesh, to health, social, and economic spheres, hampering India, Mali, and Nepal, at least half of all women their ability to negotiate their reproductive and currently ages 20 to 24 were married by age 18, broader lives, including the needs of their children. according to Demographic and Health Survey Marriage for many girls is the beginning of (DHS) data. In certain regions of Bangladesh, frequent and unprotected sexual activity. Ethiopia, India, and Nigeria, at least 40 percent The younger the bride, the more likely she is to of these women were married before age 15. If be a virgin. Frequency of sexual intercourse current patterns continue during the next decade, among married girls is far higher than among more than 100 million girls will be married before unmarried sexually active girls. Analysis of the age of 18 (considered the legal minimum DHS data shows that in 27 of 29 countries, age of marriage in most countries), according to more than half of recent unprotected sexual a Population Council analysis of United Nations activity occurs within marriage.2 country data. Early marriage among boys is much Married girls, under pressure to become preg- less common. nant, are likely to face the risks of childbirth. First births carry special risks for both mother Policy and program managers are working in two and child, and 90 percent of first births that primary ways to address the disadvantages faced occur before age 18 occur within marriage, by girls who marry early: to support later age of according to an analysis of DHS data by the marriage and to respond to the needs of young Population Council. First-time mothers younger married girls. In this article, “girls” refers to those than age 16 are at greater risk of maternal under age 18. and infant mortality.3 Married girls have distinct and in some settings that married girls, who often move to their substantial risks of acquiring HIV. Child brides husbands’ communities, are far less likely than have frequent, unprotected sex, often with their unmarried peers to have friendship an older partner. The younger the bride, the networks and the decision-making power and larger the age gap with her spouse. Older males spaces in which to meet friends and peers.10 are more likely to be sexually experienced and may thus have an elevated risk of being Married girls may be at greater risk of gender- HIV-infected. In Kisumu, Kenya, and Ndola, based violence in some settings. An analysis Zambia, studies using bio-markers found higher of DHS data from nine countries found that, HIV infection rates among married girls ages controlling for other characteristics, in about 15 to 19 compared to sexually active unmarried half the countries (Egypt, Haiti, India, and girls of the same age (33 percent compared Nicaragua) young age at marriage significantly To help reduce to 22 percent in Kenya, and 27 percent increased a girl’s or woman’s risk of ever early marriage, compared to 16 percent in Zambia).4 experiencing violence.11 programs can foster Young married girls have low educational attainment and few schooling opportunities. Delay the Age of Marriage policies and norms Across regions, the percentage of girls married To help reduce early marriage, programs can foster that support later by age 18 decreases as the number of years of schooling a girl has received increases.5 policies and norms that support later marriage marriage and offer Married girls rarely attend school. and offer services, resources, and options to families to delay marriage. services, resources, Married girls have less household and economic power than married women. Population Council and options to analyses of data from Egypt and Kenya, and Assuring girls’ school attendance, even if not at families to delay from a study in India, indicate that married girls the appropriate grade for age, is protective of girls have less decision-making power than married reproductive health, fostering delayed marriage, marriage. women, often living with little authority under delayed sexual debut, and, among those sexually the supervision of their new mothers-in-law.6 active, increased contraceptive and condom use. Married girls have less mobility than their Specific programs of substantial scale, such as unmarried counterparts or married women. those in Bangladesh and Mexico, have improved Analyses of data from Population Council projects schooling outcomes for girls.12 in India and Kenya, and a study in Bangladesh, found significant differences in the mobility Providing economic opportunities can also delay of married girls, measuring how often they went the age of marriage. Unmarried girls’ participation to such places as a tea stall, another neighbor- in wage-earning factory work in the garment hood, restaurant, bank, or post office.7 industry in Bangladesh increased the average age Married girls have less exposure to modern at marriage both among the working girls and media. Studies in Bangladesh, Ethiopia, and the nonworking girls who live in the communities Nepal, as well as the Kenya data analysis, of origin of the working girls.13 show that married girls are generally exposed to less media than unmarried girls or girls who married later.8 Increasingly, modern media A five-year project in Nepal found that involving are a means of providing information on repro- the community in efforts to improve opportunities ductive health and HIV prevention, increasing for unmarried girls contributed to changing social contact with the world, changing traditional attitudes about early marriage among interpersonal communications about HIV/AIDS, parents and communities. The project provided and in some cases changing social norms.9 information and services for adolescents using Married girls have limited social networks. peer education, youth clubs, street theater, and The Bangladesh study and India analysis found skills-building workshops.14 Other approaches to delaying marriage include Another project in India offers an integrated pack- developing meaningful policies regarding registering age of reproductive health information, clinical marriages and enforcing laws concerning minimum referrals and services, and related counseling. age at marriage. A related task is to work with A preliminary analysis of the project found a 10 religious leaders, parents, and others who shape percent to 25 percent increase among participants community norms to discourage marriage below in knowledge of reproductive health and sexual the legal minimum age. issues as well as more couple communication and an increase in the proportion of married girls seeking treatment for STIs.16 Provide Support to Married Girls For those who do marry at a young age, policy-makers In Nepal, a three-year project compared intervention and program managers should open new educa- models with control groups, including a group of tional opportunities, expand social networks, build married women under age 25. The project found economic assets, enhance the negotiating power that communication-based interventions, including of married girls, and provide reproductive health health fairs, talk programs, and educational events and HIV prevention information and services to for husbands, resulted in pronounced increases in married girls, and, as appropriate, to their partners. young women’s safe motherhood practices.17 Other measurements increased as well, such as contracep- Specific strategies are needed to help girls make tive knowledge and practice, but not as significantly. the transition to marriage as safely as possible. For example, a program in western Kenya is raising awareness of HIV risks associated with early marriage, ADDITIONAL RESOURCES ON MARRIED ADOLESCENT GIRLS establishing clubs for married girls, and promoting The World Health Organization, in collaboration with the United Nations Population Fund (UNFPA) voluntary counseling and testing among those and the Population Council, held a Technical Consultation on Married Adolescents in Geneva in couples newly married or contemplating marriage. December 2003 to examine the issue of married adolescents and young parents and to identify programs and research that address their needs. Background papers for the meeting are available Health strategies are needed to delay the first on the Population Council’s Web site. In addition to documents referenced in the main text of this birth, support first-time mothers, and prevent the YouthLens, other selected reports are summarized below. transmission of HIV and other sexually transmitted infections (STIs). Programs must consider the Population Council – Transitions to Adulthood Project limited mobility of married girls in order to design http://www.popcouncil.org/ta/marRI.html socially acceptable means to provide needed Married Adolescents: An Overview (2004) information, social connections, and services. The Roles, Responsibilities, and Realities of Married Adolescent Males and Adolescent Fathers: A Brief Literature Review (2004) The First-time Parents Project in India offers one Child Marriage Briefing Sheets, with Information on Ethiopia, Mali, Mozambique, model. Through household visits, it provides infor- Nigeria, and Zambia (2004) mation on birth spacing, safe delivery, postpartum The Experience of Adolescence in Rural Amhara Region Ethiopia (2004) care, and partner communication to married Transitions to Adulthood Brief Numbers 3, 6, 8, 9 and forthcoming on early marriage and girls and their husbands. To increase married girls’ child marriage and HIV (2005) connections with non-familial peers and mentors The International Center for Research on Women (ICRW) and to enhance their ability to act on their own When Marriage Is No Haven: Child Marriage in Developing Countries (2004). behalf, the project organizes girls who are recently Available: http://www.icrw.org/docs/2004_info_childmarriage.pdf married and pregnant or postpartum for the first ICRW Policy Advisory on Child Marriage (2003). time into groups that engage in various social and Available: http://www.icrw.org/docs/childmarriage0803.pdf economic activities.15 The belief is that empower- ment is good in and of itself, but also that such United Nations Children’s Fund (UNICEF) efforts are needed if these girls are to benefit fully Early Marriage, A Harmful Traditional Practice: A Statistical Exploration (2005). from health interventions. Available: http://www.unicef.org/publications/index_26024.html In Nigeria, Adolescent Health and Information REFERENCES Projects works to train married and divorced ado- 1. Bruce J, Clark S. The Implications of Early Marriage for HIV/AIDS Policy. New York: Population Council, 2004. lescents in income-generation skills and to provide them with health information. Its project operates 2. Blanc A, Way A. Sexual behavior and contraceptive knowledge and use among adolescents in developing countries. Stud Fam Plann on the principle that expanded economic options 1998;29(2):106-16; Bruce. can enhance reproductive health interventions. 3. Miller S, Lester F. Meeting the Needs of the Youngest First-Time Mothers. Background paper presented at WHO/UNFPA/Population Council Technical Other types of programs might also be targeted Consultation on Married Adolescents. New York: Population Council, 2003. to married girls. Programs and policies to promote 4. Clark S. Early marriage and HIV risks in sub-Saharan Africa. Stud Fam married girls’ continuation of or return to school Plann 2004;35(3):149-60; Glynn J, Carael M, Auvert B, et al. Why do young women have a much higher prevalence of HIV than young men? A study in are needed. Given the strong filtering of information Kisumu, Kenya and Ndola, Zambia. AIDS 2001;15(Supp 4):S51-S60. and support role of husbands, mothers-in-law, 5. Mensch B. The transition to marriage. In Lloyd CB, ed. Growing Up Global: and others, and since married girls often lack ready The Changing Transitions to Adulthood in Developing Countries. access to mainstream media, media messages (Washington, DC: The National Academies Press, 2005)416-505. might be designed strategically for parents, 6. Santhya, KG, Jejeebhoy S. Sexual and reproductive health needs of married For more information, husbands, in-laws, and other gatekeepers. Some adolescent girls. Econ Polit Weekly 2003;38(41):4370-77. please contact: governments are using marriage registration 7. Amin S, Mahmud S, Huq L. Baseline Survey Report on Rural Adolescents in Bangladesh. Dhaka: Ministry of Women’s Affairs, Government of systems to provide young people with reproductive Bangladesh, 2002. health information and to visit young couples who 8. Thapa S, Mishra V. Mass media exposure among urban youth in Nepal. have recently had a child.18 Asia-Pacific Pop J 2003;18(1):5-28; Amin. 2101 Wilson Boulevard Suite 700 9. Geary CW, Mahler H, Finger W, et al. Using Global Media to Reach Youth: Arlington, VA 22201 USA Millions of girls around the world have their child- The 2002 MTV Staying Alive Campaign. Youth Issues Paper 5. Arlington, VA: telephone hood cut short and their social, educational, and Family Health International, 2005. (703) 516-9779 economic opportunities limited when they enter 10. Amin. fax into marriage before age 18, often with a stranger 11. Kishor S, Johnson K. Profiling Domestic Violence: A Multi-Country Study. (703) 516-9781 and often without their input or consent. They face Calverton, MD: ORC Macro, 2004. e-mail social isolation, unwanted sex, and potential risks 12. Lloyd CB, ed. Growing Up Global: The Changing Transitions to Adulthood in firstname.lastname@example.org to their health. Public- and private-sector leaders Developing Countries. Washington, DC: The National Academies Press, 2005. web site and programmers must work together to delay the 13. Amin S, Diamond I, Naved R, et al. Transition to adulthood of female gar- www.fhi.org/youthnet ment-factory workers in Bangladesh. Stud Fam Plann 1998;29(2):185-200. age at marriage and support married girls. 14. Mathur S, Mehta M, Malhotra A. Youth Reproductive Health in Nepal: Is Participation the Answer? Washington, DC: International Center for Research — Nicole Haberland, Erica L. Chong, and on Women, 2004. Hillary J. Bracken, with Chris Parker 15. Santhya KG, Haberland N. Empowering Young Mothers in India. Transitions to Adulthood Brief No. 8. New York: Population Council, 2005. Nicole Haberland, Erica Chong, and Hillary Bracken 16. International Center for Research on Women (ICRW). Youth, Gender, are researchers at the Population Council. Chris Parker, Well-being, and Society: Emerging Themes from Adolescent Reproductive a consultant and writer, provided editorial assistance. Health Intervention Research in India. Washington, DC: ICRW, 2004. This YouthLens is based on: Haberland N, Chong EL, 17. Center for Research on Environment, Health, and Population Activities. Bracken HJ. A World Apart: The Disadvantage and Social Determining an Effective and Replicable Communications-Based Mechanism for Improving Young Couples’ Access to and Use of Reproductive Health Isolation of Married Adolescent Girls. Brief based on Information and Services in Nepal: An Operations Research Study. background paper prepared for the WHO/UNFPA/Population Frontiers Final Report. Washington, DC: Population Council, 2005. Council Technical Consultation on Married Adolescents. 18. Mathur S, Greene M, Malhotra A. Too Young to Wed: The Lives, Rights, New York: Population Council, 2004. and Health of Young Married Girls. New York: International Center for Research on Women, 2003. YouthLens is an activity of YouthNet, a five-year program funded by the U.S. Agency for International Development to improve reproductive health and prevent HIV among young people. The YouthNet team is led by Family Health International and includes CARE USA and RTI International. August 2005